208.010. 1. In determining the eligibility of a claimant for public assistance pursuant
to this law, it shall be the duty of the division of family services to consider and take into account
all facts and circumstances surrounding the claimant, including his or her living conditions,
earning capacity, income and resources, from whatever source received, and if from all the facts
and circumstances the claimant is not found to be in need, assistance shall be denied. In
determining the need of a claimant, the costs of providing medical treatment which may be
furnished pursuant to sections 208.151 to 208.158 and 208.162 shall be disregarded. The amount
of benefits, when added to all other income, resources, support, and maintenance shall provide
such persons with reasonable subsistence compatible with decency and health in accordance with
the standards developed by the division of family services; provided, when a husband and wife
are living together, the combined income and resources of both shall be considered in
determining the eligibility of either or both. "Living together" for the purpose of this chapter is
defined as including a husband and wife separated for the purpose of obtaining medical care or
nursing home care, except that the income of a husband or wife separated for such purpose shall
be considered in determining the eligibility of his or her spouse, only to the extent that such
income exceeds the amount necessary to meet the needs (as defined by rule or regulation of the
division) of such husband or wife living separately. In determining the need of a claimant in
federally aided programs there shall be disregarded such amounts per month of earned income
in making such determination as shall be required for federal participation by the provisions of
the federal Social Security Act (42 U.S.C.A. 301 et seq.), or any amendments thereto. When
federal law or regulations require the exemption of other income or resources, the division of
family services may provide by rule or regulation the amount of income or resources to be
disregarded.

2. Benefits shall not be payable to any claimant who:

(1) Has or whose spouse with whom he or she is living has, prior to July 1, 1989, given
away or sold a resource within the time and in the manner specified in this subdivision. In
determining the resources of an individual, unless prohibited by federal statutes or regulations,
there shall be included (but subject to the exclusions pursuant to subdivisions (4) and (5) of this
subsection, and subsection 5 of this section) any resource or interest therein owned by such
individual or spouse within the twenty-four months preceding the initial investigation, or at any
time during which benefits are being drawn, if such individual or spouse gave away or sold such
resource or interest within such period of time at less than fair market value of such resource or
interest for the purpose of establishing eligibility for benefits, including but not limited to
benefits based on December, 1973, eligibility requirements, as follows:

(a) Any transaction described in this subdivision shall be presumed to have been for the
purpose of establishing eligibility for benefits or assistance pursuant to this chapter unless such
individual furnishes convincing evidence to establish that the transaction was exclusively for
some other purpose;

(b) The resource shall be considered in determining eligibility from the date of the
transfer for the number of months the uncompensated value of the disposed of resource is
divisible by the average monthly grant paid or average Medicaid payment in the state at the time
of the investigation to an individual or on his or her behalf under the program for which benefits
are claimed, provided that:

a. When the uncompensated value is twelve thousand dollars or less, the resource shall
not be used in determining eligibility for more than twenty-four months; or

b. When the uncompensated value exceeds twelve thousand dollars, the resource shall
not be used in determining eligibility for more than sixty months;

(2) The provisions of subdivision (1) of this subsection shall not apply to a transfer, other
than a transfer to claimant's spouse, made prior to March 26, 1981, when the claimant furnishes
convincing evidence that the uncompensated value of the disposed of resource or any part thereof
is no longer possessed or owned by the person to whom the resource was transferred;

(3) Has received, or whose spouse with whom he or she is living has received, benefits
to which he or she was not entitled through misrepresentation or nondisclosure of material facts
or failure to report any change in status or correct information with respect to property or income
as required by section 208.210. A claimant ineligible pursuant to this subsection shall be
ineligible for such period of time from the date of discovery as the division of family services
may deem proper; or in the case of overpayment of benefits, future benefits may be decreased,
suspended or entirely withdrawn for such period of time as the division may deem proper;

(4) Owns or possesses resources in the sum of one thousand dollars or more; provided,
however, that if such person is married and living with spouse, he or she, or they, individually
or jointly, may own resources not to exceed two thousand dollars; and provided further, that in
the case of a temporary assistance for needy families claimant, the provision of this subsection
shall not apply;

(5) Prior to October 1, 1989, owns or possesses property of any kind or character,
excluding amounts placed in an irrevocable prearranged funeral or burial contract under chapter
436, or has an interest in property, of which he or she is the record or beneficial owner, the value
of such property, as determined by the division of family services, less encumbrances of record,
exceeds twenty-nine thousand dollars, or if married and actually living together with husband
or wife, if the value of his or her property, or the value of his or her interest in property, together
with that of such husband and wife, exceeds such amount;

(6) In the case of temporary assistance for needy families, if the parent, stepparent, and
child or children in the home owns or possesses property of any kind or character, or has an
interest in property for which he or she is a record or beneficial owner, the value of such
property, as determined by the division of family services and as allowed by federal law or
regulation, less encumbrances of record, exceeds one thousand dollars, excluding the home
occupied by the claimant, amounts placed in an irrevocable prearranged funeral or burial contract
under chapter 436, one automobile which shall not exceed a value set forth by federal law or
regulation and for a period not to exceed six months, such other real property which the family
is making a good-faith effort to sell, if the family agrees in writing with the division of family
services to sell such property and from the net proceeds of the sale repay the amount of
assistance received during such period. If the property has not been sold within six months, or
if eligibility terminates for any other reason, the entire amount of assistance paid during such
period shall be a debt due the state;

(7) Is an inmate of a public institution, except as a patient in a public medical institution.
3. In determining eligibility and the amount of benefits to be granted pursuant to
federally aided programs, the income and resources of [a relative or other person]all relatives,
members of the household and any other individuals who are twenty-one years of age or
older and living in the home shall be taken into account to the extent the income, resources,
support and maintenance are allowed by federal law or regulation to be considered.

4. In determining eligibility and the amount of benefits to be granted pursuant to
federally aided programs, the value of burial lots or any amounts placed in an irrevocable
prearranged funeral or burial contract under chapter 436 shall not be taken into account or
considered an asset of the burial lot owner or the beneficiary of an irrevocable prearranged
funeral or funeral contract. For purposes of this section, "burial lots" means any burial space as
defined in section 214.270 and any memorial, monument, marker, tombstone or letter marking
a burial space. If the beneficiary, as defined in chapter 436, of an irrevocable prearranged funeral
or burial contract receives any public assistance benefits pursuant to this chapter and if the
purchaser of such contract or his or her successors in interest transfer, amend, or take any other
such actions regarding the contract so that any person will be entitled to a refund, such refund
shall be paid to the state of Missouri with any amount in excess of the public assistance benefits
provided under this chapter to be refunded by the state of Missouri to the purchaser or his or her
successors. In determining eligibility and the amount of benefits to be granted under federally
aided programs, the value of any life insurance policy where a seller or provider is made the
beneficiary or where the life insurance policy is assigned to a seller or provider, either being in
consideration for an irrevocable prearranged funeral contract under chapter 436, shall not be
taken into account or considered an asset of the beneficiary of the irrevocable prearranged funeral
contract.

5. In determining the total property owned pursuant to subdivision (5) of subsection 2
of this section, or resources, of any person claiming or for whom public assistance is claimed,
there shall be disregarded any life insurance policy, or prearranged funeral or burial contract, or
any two or more policies or contracts, or any combination of policies and contracts, which
provides for the payment of one thousand five hundred dollars or less upon the death of any of
the following:

(1) A claimant or person for whom benefits are claimed; or

(2) The spouse of a claimant or person for whom benefits are claimed with whom he or
she is living. If the value of such policies exceeds one thousand five hundred dollars, then the
total value of such policies may be considered in determining resources; except that, in the case
of temporary assistance for needy families, there shall be disregarded any prearranged funeral
or burial contract, or any two or more contracts, which provides for the payment of one thousand
five hundred dollars or less per family member.

6. Beginning September 30, 1989, when determining the eligibility of institutionalized
spouses, as defined in 42 U.S.C. Section 1396r-5, for medical assistance benefits as provided for
in section 208.151 and 42 U.S.C. Sections 1396a, et seq., the division of family services shall
comply with the provisions of the federal statutes and regulations. As necessary, the division
shall by rule or regulation implement the federal law and regulations which shall include but not
be limited to the establishment of income and resource standards and limitations. The division
shall require:

(1) That at the beginning of a period of continuous institutionalization that is expected
to last for thirty days or more, the institutionalized spouse, or the community spouse, may request
an assessment by the division of family services of total countable resources owned by either or
both spouses;

(2) That the assessed resources of the institutionalized spouse and the community spouse
may be allocated so that each receives an equal share;

(3) That upon an initial eligibility determination, if the community spouse's share does
not equal at least twelve thousand dollars, the institutionalized spouse may transfer to the
community spouse a resource allowance to increase the community spouse's share to twelve
thousand dollars;

(4) That in the determination of initial eligibility of the institutionalized spouse, no
resources attributed to the community spouse shall be used in determining the eligibility of the
institutionalized spouse, except to the extent that the resources attributed to the community
spouse do exceed the community spouse's resource allowance as defined in 42 U.S.C. Section
1396r-5;

(5) That beginning in January, 1990, the amount specified in subdivision (3) of this
subsection shall be increased by the percentage increase in the Consumer Price Index for All
Urban Consumers between September, 1988, and the September before the calendar year
involved; and

(6) That beginning the month after initial eligibility for the institutionalized spouse is
determined, the resources of the community spouse shall not be considered available to the
institutionalized spouse during that continuous period of institutionalization.

7. Beginning July 1, 1989, institutionalized individuals shall be ineligible for the periods
required and for the reasons specified in 42 U.S.C. Section 1396p.

8. The hearings required by 42 U.S.C. Section 1396r-5 shall be conducted pursuant to
the provisions of section 208.080.

9. Beginning October 1, 1989, when determining eligibility for assistance pursuant to
this chapter there shall be disregarded unless otherwise provided by federal or state statutes the
home of the applicant or recipient when the home is providing shelter to the applicant or
recipient, or his or her spouse or dependent child. The division of family services shall establish
by rule or regulation in conformance with applicable federal statutes and regulations a definition
of the home and when the home shall be considered a resource that shall be considered in
determining eligibility.

10. Reimbursement for services provided by an enrolled Medicaid provider to a recipient
who is duly entitled to Title XIX Medicaid and Title XVIII Medicare Part B, Supplementary
Medical Insurance (SMI) shall include payment in full of deductible and coinsurance amounts
as determined due pursuant to the applicable provisions of federal regulations pertaining to Title
XVIII Medicare Part B, except for hospital outpatient services or the applicable Title XIX cost
sharing.

11. A "community spouse" is defined as being the noninstitutionalized spouse.

12. An institutionalized spouse applying for Medicaid and having a spouse living in the
community shall be required, to the maximum extent permitted by law, to divert income to such
community spouse to raise the community spouse's income to the level of the minimum monthly
needs allowance, as described in 42 U.S.C. Section 1396r-5. Such diversion of income shall
occur before the community spouse is allowed to retain assets in excess of the community spouse
protected amount described in 42 U.S.C. Section 1396r-5.

208.022. All electronic benefits cards distributed to recipients of temporary assistance
for needy families benefits shall have imprinted on the card a photograph of the recipient or
protective payee authorized to use the card and shall expire and be subject to renewal after a
period of three years. Retail establishments shall be required to verify that the photograph
on the card matches the identity of the person presenting the card. The card shall not be
accepted for use by a retail establishment if the photograph of the recipient does not match the
person presenting the card.

208.027. 1. The department of social services shall develop a program to screen each
applicant or recipient who is otherwise eligible for temporary assistance for needy families
benefits under this chapter, and then test, using a urine dipstick five panel test, each one who the
department has reasonable cause to believe, based on the screening, engages in illegal use of
controlled substances. Any applicant or recipient who is found to have tested positive for the use
of a controlled substance, which was not prescribed for such applicant or recipient by a licensed
health care provider, or who refuses to submit to a test, shall, after an administrative hearing
conducted by the department under the provisions of chapter 536, be declared ineligible for
temporary assistance for needy families benefits for a period of three years from the date of the
administrative hearing decision unless such applicant or recipient, after having been referred by
the department, enters and successfully completes a substance abuse treatment program and does
not test positive for illegal use of a controlled substance in the six-month period beginning on
the date of entry into such rehabilitation or treatment program. The applicant or recipient shall
continue to receive benefits while participating in the treatment program. The department may
test the applicant or recipient for illegal drug use at random or set intervals, at the department's
discretion, after such period. If the applicant or recipient tests positive for the use of illegal drugs
a second time, then such applicant or recipient shall be declared ineligible for temporary
assistance for needy families benefits for a period of three years from the date of the
administrative hearing decision. The department shall refer an applicant or recipient who tested
positive for the use of a controlled substance under this section to an appropriate substance abuse
treatment program approved by the division of alcohol and drug abuse within the department of
mental health.

2. Case workers of applicants or recipients shall be required to report or cause a report
to be made to the children's division in accordance with the provisions of sections 210.109 to
210.183 for suspected child abuse as a result of drug abuse in instances where the case worker
has knowledge that:

(1) An applicant or recipient has tested positive for the illegal use of a controlled
substance; or

(2) An applicant or recipient has refused to be tested for the illegal use of a controlled
substance.

3. Other members of a household which includes a person who has been declared
ineligible for temporary assistance for needy families assistance shall, if otherwise eligible,
continue to receive temporary assistance for needy families benefits as protective or vendor
payments to a third-party payee for the benefit of the members of the household.

4. The department of social services shall promulgate rules to develop the screening and
testing provisions of this section. Any rule or portion of a rule, as that term is defined in section
536.010, that is created under the authority delegated in this section shall become effective only
if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section
536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the
general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove
and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority
and any rule proposed or adopted after August 28, 2011, shall be invalid and void.

5. Notwithstanding the department's screening program developed pursuant to
subsection 1, case workers shall be given the ultimate discretion to determine whether there
is reasonable cause to believe an applicant or recipient engages in the illegal use of
controlled substances. The department is prohibited from promulgating any rule or policy
that would prohibit a case worker of applicants or recipients from requiring a test for any
applicant or recipient the case worker has reasonable cause to believe engages in the illegal
use of controlled substances.

6. Any department employee who prohibits the drug testing of an applicant or
recipient when the case worker has reasonable cause to believe the applicant or recipient
engages in the illegal use of controlled substances shall be subject to immediate termination
of employment.

208.031. 1. Electronic benefit transfer transactions made by each applicant or
recipient who is otherwise eligible for temporary assistance for needy families benefits
under this chapter and who is found to have made a cash withdrawal at any casino,
gambling casino, or gaming establishment shall, after an administrative hearing conducted
by the department under the provisions of chapter 536, be declared ineligible for
temporary assistance for needy families benefits for a period of three years from the date
of the administrative hearing decision. For purposes of this section, "casino, gambling
casino, or gaming establishment" does not include a grocery store which sells groceries
including staple foods and which also offers, or is located within the same building or
complex as, casino, gambling, or gaming activities.

2. Other members of a household which includes a person who has been declared
ineligible for temporary assistance for needy families assistance shall, if otherwise eligible,
continue to receive temporary assistance for needy families benefits as protective or vendor
payments to a third-party payee for the benefit of the members of the household.

3. Any person who, in good faith, reports a suspected violation of this section by a
temporary assistance for needy families (TANF) recipient shall not be held civilly or
criminally liable for reporting such suspected violation.

4. The department of social services shall promulgate rules to implement the
provisions of this section. Any rule or portion of a rule, as that term is defined in section
536.010, that is created under the authority delegated in this section shall become effective
only if it complies with and is subject to all of the provisions of chapter 536 and, if
applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the
powers vested with the general assembly pursuant to chapter 536 to review, to delay the
effective date, or to disapprove and annul a rule are subsequently held unconstitutional,
then the grant of rulemaking authority and any rule proposed or adopted after August 28,
2013, shall be invalid and void.

208.032. 1. In accordance with the Social Security Act, 42 U.S.C. Section 608(a)(12),
the department of social services shall implement and maintain policies and practices
which prevent a temporary assistance for needy families electronic benefit transfer
transaction in:

(1) Any liquor store;

(2) Any casino, gambling casino, or gambling establishment; or

(3) Any retail establishment which provides adult-oriented entertainment in which
performers disrobe or perform in an unclothed state for entertainment.

2. As used in this section, the term:

(1) "Casino, gambling casino, or gaming establishment" shall not include a grocery
store which sells groceries including staple foods and which also offers, or is located within
the same building or complex as, casino, gambling, or gaming activities;

(2) "Electronic benefit transfer transaction" means the use of a credit or debit card
service, automated teller machine, point-of-sale terminal, or access to an online system for
the withdrawal of funds or the processing of a payment for merchandise or a service;

(3) "Liquor store" means any retail establishment which sells exclusively or
primarily intoxicating liquor. Liquor store does not include a grocery store which sells
both intoxicating liquor and groceries including staple foods within the meaning of Section
3(r) of the Food and Nutrition Act of 2008, 7 U.S.C. Section 2012(r).

3. In accordance with 42 U.S.C. Section 602(a)(1)(A), the department of social
services shall:

(1) Implement policies and procedures as necessary to prevent access to assistance
provided under Missouri's temporary assistance for needy families (TANF) program
through any electronic fund transaction in an automated teller machine or point-of-sale
device located in a place described in subsections 1 and 2 of this section, including a plan
to ensure that recipients of the assistance have adequate access to their cash assistance; and

(2) Ensure that recipients of assistance provided under Missouri's TANF program
have access to using or withdrawing assistance with minimal fees or charges, including an
opportunity to access assistance with no fee or charges, and are provided information on
applicable fees and charges that apply to electronic fund transactions involving the
assistance, and that such information is made publicly available.

4. On or before December 31, 2014, the department shall submit a report to the
governor and the general assembly detailing the policies and practices implemented in
accordance with the requirements of this section and the requirements of 42 U.S.C. Section
608(a)(12). In addition, the department shall report Missouri's implementation of the
policies and practices to the Secretary of Health and Human Services as required under
42 U.S.C. Section 609(a)(16) within two years of the enactment of such federal law.

5. Nothing in this section shall require any casino, gambling casino, or gaming
establishment to enforce or monitor any provision of this section.

208.042. 1. In households containing recipients of [aid to families with dependent
children]temporary assistance for needy families benefits, each [appropriate child, relative
or other eligible individual]recipient sixteen years of age or over, with the exception of
recipients under the age of nineteen who are enrolled full-time in high school, shall [be
referred by the division of family services to the United States Secretary of Labor or his
representative for participation in employment, training, work incentive or special work projects
when established and operated by the secretary,]participate in work activities in accordance
with federal regulations to afford such individuals opportunities to work in the regular
economy and to attain independence through gainful employment.

2. The [division of family services]department of social services, pursuant to
applicable federal law and regulations, shall determine the standards and procedures for the
referral of individuals for [employment, training, work incentive and special work projects,]work activities, which shall not be refused by such individuals without good cause; but no
recipient [or other eligible individual in the household] shall be required to participate in such
work [programs]activities if the person is

(1) Ill, incapacitated, or of advanced age;

(2) So remote from the location of any work [or training project or program]activity that
he cannot effectively participate;

(3) A child attending school full time;

(4) A person whose presence in the household on a substantially continuous basis is
required because of illness or incapacity of another member of the household.

3. [The division of family services shall pay to the United States Secretary of Labor or
his representative up to twenty percent of the total cost, in cash or in kind, of the work incentive
programs operated for the benefit of the eligible persons referred by the division of family
services; and the division of family services shall pay an amount to the secretary for eligible
persons referred to and participating in special work projects not to exceed the maximum
monthly payments authorized under sections 208.041 and 208.150 for recipients of public
assistance benefits. An allowance in addition to the maximum fixed by section 208.150 may also
be made by the division of family services for the reasonable expenses of any needy child or
needy eligible relative which are attributable to his participating in a work training or work
incentive program.

4.] If [an eligible child or relative]a recipient refuses without good cause to participate
in any work [training or work incentive program to which he has been referred, payment to or
on behalf of the child or relative]activity, his or her benefits may be continued for not more
than sixty days thereafter, but in such cases payments shall be made pursuant to subsection 2 of
section 208.180. If a [relative]recipient has refused to so participate, payments on behalf of the
eligible children cared for by the [relative]recipient shall be made pursuant to subsection 2 of
section 208.180.

[5.]4. The [division of family services]department of social services is authorized to
expend funds to provide child day care services, when appropriate, for the care of children
required by the absence of adult persons from the household due to [referral and participation
in employment, training, work incentive programs or special work projects]work activities.

5. The provisions of this section shall be subject to compliance by the department
with all applicable federal laws and rules regarding temporary assistance for needy
families.

208.048. 1. A dependent child eighteen years of age shall, in order to retain eligibility
for aid to families with dependent children, be enrolled as a full-time student in a public or
private secondary school, or an equivalent level of vocational or technical school in lieu of
secondary school, and reasonably expected to complete the program of the secondary school, or
equivalent vocational or technical training.

2. All recipients of temporary assistance benefits shall be required to provide proof
that all dependent children who are eligible for enrollment in a public school are enrolled
and attending school, whether public, private, or home school, regularly.

[2.]3. The department of social services shall promulgate rules and regulations to carry
out the provisions of this section pursuant to section 660.017 and chapter 536.

208.152. 1. MO HealthNet payments shall be made on behalf of those eligible needy
persons as defined in section 208.151 who are unable to provide for it in whole or in part, with
any payments to be made on the basis of the reasonable cost of the care or reasonable charge for
the services as defined and determined by the MO HealthNet division, unless otherwise
hereinafter provided, for the following:

(1) Inpatient hospital services, except to persons in an institution for mental diseases who
are under the age of sixty-five years and over the age of twenty-one years; provided that the MO
HealthNet division shall provide through rule and regulation an exception process for coverage
of inpatient costs in those cases requiring treatment beyond the seventy-fifth percentile
professional activities study (PAS) or the MO HealthNet children's diagnosis length-of-stay
schedule; and provided further that the MO HealthNet division shall take into account through
its payment system for hospital services the situation of hospitals which serve a disproportionate
number of low-income patients;

(2) All outpatient hospital services, payments therefor to be in amounts which represent
no more than eighty percent of the lesser of reasonable costs or customary charges for such
services, determined in accordance with the principles set forth in Title XVIII A and B, Public
Law 89-97, 1965 amendments to the federal Social Security Act (42 U.S.C. 301, et seq.), but the
MO HealthNet division may evaluate outpatient hospital services rendered under this section and
deny payment for services which are determined by the MO HealthNet division not to be
medically necessary, in accordance with federal law and regulations;

(3) Laboratory and X-ray services;

(4) Nursing home services for participants, except to persons with more than five
hundred thousand dollars equity in their home or except for persons in an institution for mental
diseases who are under the age of sixty-five years, when residing in a hospital licensed by the
department of health and senior services or a nursing home licensed by the department of health
and senior services or appropriate licensing authority of other states or government-owned and
-operated institutions which are determined to conform to standards equivalent to licensing
requirements in Title XIX of the federal Social Security Act (42 U.S.C. 301, et seq.), as
amended, for nursing facilities. The MO HealthNet division may recognize through its payment
methodology for nursing facilities those nursing facilities which serve a high volume of MO
HealthNet patients. The MO HealthNet division when determining the amount of the benefit
payments to be made on behalf of persons under the age of twenty-one in a nursing facility may
consider nursing facilities furnishing care to persons under the age of twenty-one as a
classification separate from other nursing facilities;

(5) Nursing home costs for participants receiving benefit payments under subdivision
(4) of this subsection for those days, which shall not exceed twelve per any period of six
consecutive months, during which the participant is on a temporary leave of absence from the
hospital or nursing home, provided that no such participant shall be allowed a temporary leave
of absence unless it is specifically provided for in his plan of care. As used in this subdivision,
the term "temporary leave of absence" shall include all periods of time during which a participant
is away from the hospital or nursing home overnight because he is visiting a friend or relative;

(7) Drugs and medicines when prescribed by a licensed physician, dentist, or podiatrist;
except that no payment for drugs and medicines prescribed on and after January 1, 2006, by a
licensed physician, dentist, or podiatrist may be made on behalf of any person who qualifies for
prescription drug coverage under the provisions of P.L. 108-173;

(9) Early and periodic screening and diagnosis of individuals who are under the age of
twenty-one to ascertain their physical or mental defects, and health care, treatment, and other
measures to correct or ameliorate defects and chronic conditions discovered thereby. Such
services shall be provided in accordance with the provisions of Section 6403 of P.L. 101-239 and
federal regulations promulgated thereunder;

(10) Home health care services;

(11) Family planning as defined by federal rules and regulations; provided, however, that
such family planning services shall not include abortions unless such abortions are certified in
writing by a physician to the MO HealthNet agency that, in his professional judgment, the life
of the mother would be endangered if the fetus were carried to term;

(12) Inpatient psychiatric hospital services for individuals under age twenty-one as
defined in Title XIX of the federal Social Security Act (42 U.S.C. 1396d, et seq.);

(13) Outpatient surgical procedures, including presurgical diagnostic services performed
in ambulatory surgical facilities which are licensed by the department of health and senior
services of the state of Missouri; except, that such outpatient surgical services shall not include
persons who are eligible for coverage under Part B of Title XVIII, Public Law 89-97, 1965
amendments to the federal Social Security Act, as amended, if exclusion of such persons is
permitted under Title XIX, Public Law 89-97, 1965 amendments to the federal Social Security
Act, as amended;

(14) Personal care services which are medically oriented tasks having to do with a
person's physical requirements, as opposed to housekeeping requirements, which enable a person
to be treated by his physician on an outpatient rather than on an inpatient or residential basis in
a hospital, intermediate care facility, or skilled nursing facility. Personal care services shall be
rendered by an individual not a member of the participant's family who is qualified to provide
such services where the services are prescribed by a physician in accordance with a plan of
treatment and are supervised by a licensed nurse. Persons eligible to receive personal care
services shall be those persons who would otherwise require placement in a hospital,
intermediate care facility, or skilled nursing facility. Benefits payable for personal care services
shall not exceed for any one participant one hundred percent of the average statewide charge for
care and treatment in an intermediate care facility for a comparable period of time. Such
services, when delivered in a residential care facility or assisted living facility licensed under
chapter 198 shall be authorized on a tier level based on the services the resident requires and the
frequency of the services. A resident of such facility who qualifies for assistance under section
208.030 shall, at a minimum, if prescribed by a physician, qualify for the tier level with the
fewest services. The rate paid to providers for each tier of service shall be set subject to
appropriations. Subject to appropriations, each resident of such facility who qualifies for
assistance under section 208.030 and meets the level of care required in this section shall, at a
minimum, if prescribed by a physician, be authorized up to one hour of personal care services
per day. Authorized units of personal care services shall not be reduced or tier level lowered
unless an order approving such reduction or lowering is obtained from the resident's personal
physician. Such authorized units of personal care services or tier level shall be transferred with
such resident if her or she transfers to another such facility. Such provision shall terminate upon
receipt of relevant waivers from the federal Department of Health and Human Services. If the
Centers for Medicare and Medicaid Services determines that such provision does not comply
with the state plan, this provision shall be null and void. The MO HealthNet division shall notify
the revisor of statutes as to whether the relevant waivers are approved or a determination of
noncompliance is made;

(15) Mental health services. The state plan for providing medical assistance under Title
XIX of the Social Security Act, 42 U.S.C. 301, as amended, shall include the following mental
health services when such services are provided by community mental health facilities operated
by the department of mental health or designated by the department of mental health as a
community mental health facility or as an alcohol and drug abuse facility or as a child-serving
agency within the comprehensive children's mental health service system established in section
630.097. The department of mental health shall establish by administrative rule the definition
and criteria for designation as a community mental health facility and for designation as an
alcohol and drug abuse facility. Such mental health services shall include:

(a) Outpatient mental health services including preventive, diagnostic, therapeutic,
rehabilitative, and palliative interventions rendered to individuals in an individual or group
setting by a mental health professional in accordance with a plan of treatment appropriately
established, implemented, monitored, and revised under the auspices of a therapeutic team as a
part of client services management;

(b) Clinic mental health services including preventive, diagnostic, therapeutic,
rehabilitative, and palliative interventions rendered to individuals in an individual or group
setting by a mental health professional in accordance with a plan of treatment appropriately
established, implemented, monitored, and revised under the auspices of a therapeutic team as a
part of client services management;

(c) Rehabilitative mental health and alcohol and drug abuse services including home and
community-based preventive, diagnostic, therapeutic, rehabilitative, and palliative interventions
rendered to individuals in an individual or group setting by a mental health or alcohol and drug
abuse professional in accordance with a plan of treatment appropriately established,
implemented, monitored, and revised under the auspices of a therapeutic team as a part of client
services management. As used in this section, mental health professional and alcohol and drug
abuse professional shall be defined by the department of mental health pursuant to duly
promulgated rules. With respect to services established by this subdivision, the department of
social services, MO HealthNet division, shall enter into an agreement with the department of
mental health. Matching funds for outpatient mental health services, clinic mental health
services, and rehabilitation services for mental health and alcohol and drug abuse shall be
certified by the department of mental health to the MO HealthNet division. The agreement shall
establish a mechanism for the joint implementation of the provisions of this subdivision. In
addition, the agreement shall establish a mechanism by which rates for services may be jointly
developed;

(16) Such additional services as defined by the MO HealthNet division to be furnished
under waivers of federal statutory requirements as provided for and authorized by the federal
Social Security Act (42 U.S.C. 301, et seq.) subject to appropriation by the general assembly;

(17) Beginning July 1, 1990, the services of a certified pediatric or family nursing
practitioner with a collaborative practice agreement to the extent that such services are provided
in accordance with chapters 334 and 335, and regulations promulgated thereunder;

(18) Nursing home costs for participants receiving benefit payments under subdivision
(4) of this subsection to reserve a bed for the participant in the nursing home during the time that
the participant is absent due to admission to a hospital for services which cannot be performed
on an outpatient basis, subject to the provisions of this subdivision:

(a) The provisions of this subdivision shall apply only if:

a. The occupancy rate of the nursing home is at or above ninety-seven percent of MO
HealthNet certified licensed beds, according to the most recent quarterly census provided to the
department of health and senior services which was taken prior to when the participant is
admitted to the hospital; and

b. The patient is admitted to a hospital for a medical condition with an anticipated stay
of three days or less;

(b) The payment to be made under this subdivision shall be provided for a maximum of
three days per hospital stay;

(c) For each day that nursing home costs are paid on behalf of a participant under this
subdivision during any period of six consecutive months such participant shall, during the same
period of six consecutive months, be ineligible for payment of nursing home costs of two
otherwise available temporary leave of absence days provided under subdivision (5) of this
subsection; and

(d) The provisions of this subdivision shall not apply unless the nursing home receives
notice from the participant or the participant's responsible party that the participant intends to
return to the nursing home following the hospital stay. If the nursing home receives such
notification and all other provisions of this subsection have been satisfied, the nursing home shall
provide notice to the participant or the participant's responsible party prior to release of the
reserved bed;

(19) Prescribed medically necessary durable medical equipment. An electronic web-based prior authorization system using best medical evidence and care and treatment guidelines
consistent with national standards shall be used to verify medical need;

(20) Hospice care. As used in this subdivision, the term "hospice care" means a
coordinated program of active professional medical attention within a home, outpatient and
inpatient care which treats the terminally ill patient and family as a unit, employing a medically
directed interdisciplinary team. The program provides relief of severe pain or other physical
symptoms and supportive care to meet the special needs arising out of physical, psychological,
spiritual, social, and economic stresses which are experienced during the final stages of illness,
and during dying and bereavement and meets the Medicare requirements for participation as a
hospice as are provided in 42 CFR Part 418. The rate of reimbursement paid by the MO
HealthNet division to the hospice provider for room and board furnished by a nursing home to
an eligible hospice patient shall not be less than ninety-five percent of the rate of reimbursement
which would have been paid for facility services in that nursing home facility for that patient,
in accordance with subsection (c) of Section 6408 of P.L. 101-239 (Omnibus Budget
Reconciliation Act of 1989);

(21) Prescribed medically necessary dental services. Such services shall be subject to
appropriations. An electronic web-based prior authorization system using best medical evidence
and care and treatment guidelines consistent with national standards shall be used to verify
medical need;

(22) Prescribed medically necessary optometric services. Such services shall be subject
to appropriations. An electronic web-based prior authorization system using best medical
evidence and care and treatment guidelines consistent with national standards shall be used to
verify medical need;

(23) Blood clotting products-related services. For persons diagnosed with a bleeding
disorder, as defined in section 338.400, reliant on blood clotting products, as defined in section
338.400, such services include:

(a) Home delivery of blood clotting products and ancillary infusion equipment and
supplies, including the emergency deliveries of the product when medically necessary;

(c) Assessments conducted in the participant's home by a pharmacist, nurse, or local
home health care agency trained in bleeding disorders when deemed necessary by the
participant's treating physician;

(24) The MO HealthNet division shall, by January 1, 2008, and annually thereafter,
report the status of MO HealthNet provider reimbursement rates as compared to one hundred
percent of the Medicare reimbursement rates and compared to the average dental reimbursement
rates paid by third-party payors licensed by the state. The MO HealthNet division shall, by
July 1, 2008, provide to the general assembly a four-year plan to achieve parity with Medicare
reimbursement rates and for third-party payor average dental reimbursement rates. Such plan
shall be subject to appropriation and the division shall include in its annual budget request to the
governor the necessary funding needed to complete the four-year plan developed under this
subdivision.

2. Additional benefit payments for medical assistance shall be made on behalf of those
eligible needy children, pregnant women and blind persons with any payments to be made on the
basis of the reasonable cost of the care or reasonable charge for the services as defined and
determined by the division of medical services, unless otherwise hereinafter provided, for the
following:

(5) Hospice care. As used in this subsection, the term "hospice care" means a
coordinated program of active professional medical attention within a home, outpatient and
inpatient care which treats the terminally ill patient and family as a unit, employing a medically
directed interdisciplinary team. The program provides relief of severe pain or other physical
symptoms and supportive care to meet the special needs arising out of physical, psychological,
spiritual, social, and economic stresses which are experienced during the final stages of illness,
and during dying and bereavement and meets the Medicare requirements for participation as a
hospice as are provided in 42 CFR Part 418. The rate of reimbursement paid by the MO
HealthNet division to the hospice provider for room and board furnished by a nursing home to
an eligible hospice patient shall not be less than ninety-five percent of the rate of reimbursement
which would have been paid for facility services in that nursing home facility for that patient,
in accordance with subsection (c) of Section 6408 of P.L. 101-239 (Omnibus Budget
Reconciliation Act of 1989);

(6) Comprehensive day rehabilitation services beginning early posttrauma as part of a
coordinated system of care for individuals with disabling impairments. Rehabilitation services
must be based on an individualized, goal-oriented, comprehensive and coordinated treatment
plan developed, implemented, and monitored through an interdisciplinary assessment designed
to restore an individual to optimal level of physical, cognitive, and behavioral function. The MO
HealthNet division shall establish by administrative rule the definition and criteria for
designation of a comprehensive day rehabilitation service facility, benefit limitations and
payment mechanism. Any rule or portion of a rule, as that term is defined in section 536.010,
that is created under the authority delegated in this subdivision shall become effective only if it
complies with and is subject to all of the provisions of chapter 536 and, if applicable, section
536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the
general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove
and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority
and any rule proposed or adopted after August 28, 2005, shall be invalid and void.

3. The MO HealthNet division may require any participant receiving MO HealthNet
benefits to pay part of the charge or cost until July 1, 2008, and an additional payment after
July 1, 2008, as defined by rule duly promulgated by the MO HealthNet division, for all covered
services except for those services covered under subdivisions (14) and (15) of subsection 1 of
this section and sections 208.631 to 208.657 to the extent and in the manner authorized by Title
XIX of the federal Social Security Act (42 U.S.C. 1396, et seq.) and regulations thereunder.
When substitution of a generic drug is permitted by the prescriber according to section 338.056,
and a generic drug is substituted for a name-brand drug, the MO HealthNet division may not
lower or delete the requirement to make a co-payment pursuant to regulations of Title XIX of
the federal Social Security Act. A provider of goods or services described under this section
must collect from all participants the additional payment that may be required by the MO
HealthNet division under authority granted herein, if the division exercises that authority, to
remain eligible as a provider. Any payments made by participants under this section shall be in
addition to and not in lieu of payments made by the state for goods or services described herein
except the participant portion of the pharmacy professional dispensing fee shall be in addition
to and not in lieu of payments to pharmacists. A provider may collect the co-payment at the time
a service is provided or at a later date. A provider shall not refuse to provide a service if a
participant is unable to pay a required payment. If it is the routine business practice of a provider
to terminate future services to an individual with an unclaimed debt, the provider may include
uncollected co-payments under this practice. Providers who elect not to undertake the provision
of services based on a history of bad debt shall give participants advance notice and a reasonable
opportunity for payment. A provider, representative, employee, independent contractor, or agent
of a pharmaceutical manufacturer shall not make co-payment for a participant. This subsection
shall not apply to other qualified children, pregnant women, or blind persons. If the Centers for
Medicare and Medicaid Services does not approve the Missouri MO HealthNet state plan
amendment submitted by the department of social services that would allow a provider to deny
future services to an individual with uncollected co-payments, the denial of services shall not be
allowed. The department of social services shall inform providers regarding the acceptability
of denying services as the result of unpaid co-payments.

4. The MO HealthNet division shall have the right to collect medication samples from
participants in order to maintain program integrity.

5. Reimbursement for obstetrical and pediatric services under subdivision (6) of
subsection 1 of this section shall be timely and sufficient to enlist enough health care providers
so that care and services are available under the state plan for MO HealthNet benefits at least to
the extent that such care and services are available to the general population in the geographic
area, as required under subparagraph (a)(30)(A) of 42 U.S.C. 1396a and federal regulations
promulgated thereunder.

7. Beginning July 1, 1990, the department of social services shall provide notification
and referral of children below age five, and pregnant, breast-feeding, or postpartum women who
are determined to be eligible for MO HealthNet benefits under section 208.151 to the special
supplemental food programs for women, infants and children administered by the department
of health and senior services. Such notification and referral shall conform to the requirements
of Section 6406 of P.L. 101-239 and regulations promulgated thereunder.

8. Providers of long-term care services shall be reimbursed for their costs in accordance
with the provisions of Section 1902 (a)(13)(A) of the Social Security Act, 42 U.S.C. 1396a, as
amended, and regulations promulgated thereunder.

9. Reimbursement rates to long-term care providers with respect to a total change in
ownership, at arm's length, for any facility previously licensed and certified for participation in
the MO HealthNet program shall not increase payments in excess of the increase that would
result from the application of Section 1902 (a)(13)(C) of the Social Security Act, 42 U.S.C.
1396a (a)(13)(C).

11. Any income earned by individuals eligible for certified extended employment at a
sheltered workshop under chapter 178 shall not be considered as income for purposes of
determining eligibility under this section.

12. The MO HealthNet division shall screen all recipients of MO HealthNet benefits
to determine if such recipients are eligible to participate in the health insurance premium
payment (HIPP) program. All eligible recipients shall participate in the HIPP program if
it is determined to be cost effective for the division.

208.182. 1. [The division of family services shall establish pilot projects in St. Louis
City and in any county with a population of six hundred thousand or more, which shall provide
for a system of electronic transfer of benefits to public assistance recipients. Such system shall
allow recipients to obtain cash from automated teller machines or point of sale terminals. If less
than the total amount of benefits is withdrawn, the recipient shall be given a receipt showing the
current status of his account.]All electronic benefit cards distributed to food stamp recipients
shall have imprinted on the card a photograph of the recipient and shall expire and be
subject to renewal after a period of three years. Retail establishments shall be required to
verify that the photograph on the card matches the identity of the person presenting the
card. The card shall not be accepted for use by a retail establishment if the photograph of
the recipient does not match the person presenting the card.

2. The disclosure of any information provided to a financial institution, business or
vendor by the [division of family services]department pursuant to this section is prohibited.
Such financial institution, business or vendor may not use or sell such information and may not
divulge the information without a court order. Violation of this subsection is a class A
misdemeanor.

3. [Subject to appropriations and subject to receipt of waivers from the federal
government to prevent the loss of any federal funds, the department of social services shall
require the use of photographic identification on electronic benefit transfer cards issued to
recipients in this system. Such photographic identification electronic benefit transfer card shall
be in a form approved by the department of social services.

4.] The [division of family services]department shall promulgate rules and regulations
necessary to implement the provisions of this section pursuant to section 660.017 and chapter
536. The rules shall ensure compliance with federal law, taking into account individuals
and households with special needs as well as ensuring that all appropriate household
members or authorized representatives are able to access benefits as necessary.

[5.]4. The delivery of electronic benefits and the electronic eligibility verification,
including, but not limited to, [aid to families with dependent children (AFDC)]temporary
assistance for needy families (TANF), women, infants and children (WIC), early periodic
screening diagnosis and treatment (EPSDT), food stamps, supplemental security income (SSI),
including Medicaid, child support, and other programs, shall reside in one card that may be
enabled by function from time to time in a convenient manner.

208.249. 1. As used in this section, the following terms mean:

(1) “Department”, the department of social services;

(2) “Fraud”, a known false representation, including the concealment of a material
fact, upon which the recipient claims eligibility for public assistance benefits;

(3) “Public assistance benefits”, temporary assistance for needy families benefits,
food stamps, medical assistance, or other similar assistance administered by the
department of social services or other state department;

(4) “Recipient”, a person who is eligible to receive public assistance benefits.

2. Any person who knowingly and intentionally commits fraud in obtaining or
attempting to obtain public assistance benefits shall lose eligibility for public assistance
benefits permanently.

3. Any persons who, based upon their personal knowledge, have reasonable cause
to believe an act of public assistance benefits fraud is being committed shall report such
act to the department. When a report of suspected public assistance benefits fraud is
received by the department, the department shall investigate such report. An investigation
of public assistance benefits fraud shall be initiated by the department within fifteen days
of receipt of the report. Absent good cause, any investigation shall be concluded within
sixty days of receipt of the report. The burden of conducting the investigation rests with
the fraud investigator or fraud unit and not the recipient’s caseworker. Failure to comply
with the provisions of this section shall be grounds for termination of employment. The
investigation must include:

(1) A request for the employment records and pay stubs of the recipient covering
the previous six months;

(2) Verification of all individuals living in the household of the recipient;

(3) A copy of any rental agreement for the residence or a copy of the deed of the
home;

(4) A copy of any court order regarding custody of any minor children living in the
home; and

(5) The state and federal tax returns of the recipient for the previous two years.

Section 1. Notwithstanding any provision of law to the contrary, the department
shall establish and implement a welfare-to-work program that requires all recipients of
temporary assistance for needy families benefits to make at least twenty job contacts per
week. The department shall allow recipients to work as unpaid interns for a governmental
entity and shall only require those working as interns to make at least ten job contacts per
week. After the first month of making job contacts, any recipient of temporary assistance
for needy families benefits that has not obtained employment that provides on average
twenty hours per week of employment shall be required to work as an unpaid intern for
a governmental entity and shall only be required to make at least ten job contacts per
week. Any county, city or other political subdivision shall be allowed to submit to the
department available intern positions in which temporary assistance recipients may be
placed. The provisions of this section shall not apply to any recipient under the age of
nineteen who is enrolled in high school full-time. The director of the department of social
services shall apply for all waivers of requirements under federal law necessary to
implement the provisions of this section with full federal participation. The provisions of
this section shall be implemented, subject to appropriation, as waivers necessary to ensure
continued federal participation are received.

Section 2. All recipients of temporary assistance for needy families, food stamps,
child care assistance, supplemental nutrition assistance, or any other similar governmental
assistance program who are eighteen years of age or older shall be required to possess a
high school diploma or graduate equivalency degree. Any applicant for temporary
assistance for needy families, food stamps, child care assistance, supplemental nutrition
assistance, or any other similar governmental assistance program who, at the time of their
application for assistance, does not possess a high school diploma or graduate equivalency
degree as required by these provisions shall have two years from the date of the application
for assistance to obtain a high school diploma. If all other eligibility requirements are
satisfied, the applicant shall receive assistance during such two-year period. The director
of the department of social services shall apply for all waivers of requirements under
federal law necessary to implement the provisions of this section with full federal
participation. The provisions of this section shall be implemented, subject to appropriation,
as waivers necessary to ensure continued federal participation are received.